Provider Demographics
NPI:1982670907
Name:MAXWELL, STEPHEN A (AUD)
Entity type:Individual
Prefix:PROF
First Name:STEPHEN
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E BROADWAY
Mailing Address - Street 2:UNIT 94
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1024
Mailing Address - Country:US
Mailing Address - Phone:480-313-5868
Mailing Address - Fax:
Practice Address - Street 1:ARIZONA STATE UNIVERSITY
Practice Address - Street 2:LATTIE CORR HALL ROOM #2358
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0102
Practice Address - Country:US
Practice Address - Phone:480-727-0640
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA4789231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist